Twin-to-Twin Transfusion Syndrome Clinical Presentation

Updated: Aug 03, 2018
  • Author: Terence Zach, MD; Chief Editor: Ronald M Ramus, MD  more...
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Women with twin pregnancies who develop twin-to-twin transfusion syndrome (TTTS) frequently complain of a rapidly enlarging abdomen over 2-3 weeks as polyhydramnios develops in the amniotic sac of the recipient twin.

Other complaints include preterm labor and premature rupture of membranes.



TTTS should be considered in a pregnant woman carrying monochorionic twins if she develops a rapidly increasing fundal height. After birth, TTTS can be considered if the twins are monozygotic, and significant differences occur in the size or appearance of the twins.

Donor twin features include the following:

  • Small for gestational age - More than 20% smaller than recipient twin

  • Pallor

  • Poor peripheral perfusion

Recipient twin features include the following:

  • Large for gestational age - More than 20% larger than donor twin

  • Plethoric and ruddy

  • Jaundice

Hydrops fetalis can be present in either twin in TTTS. These infants have subcutaneous edema, a distended abdomen, and respiratory distress.



TTTS occurs in monozygotic, monochorionic twin pregnancies when an anastomosis between placental vasculature exists.